title: Grading of hypervascular hepatocellular carcinoma using late phase of contrast enhanced sonography - a prospective study.
abstract: BACKGROUND
  Outcome of patients with hepatocellular carcinoma is influenced by their histological grade. Invasive biopsy of the lesions is the gold standard in this regard.
  
  
  OBJECTIVE
  We therefore analysed the diagnostic accuracy of contrast enhanced ultrasound for non-invasive grading of hypervascular hepatocellular carcinoma in liver cirrhosis.
  
  
  METHODS
  According to the tumour perfusion kinetics on contrast enhanced ultrasound two grading groups were prospectively defined: well-differentiated hepatocellular carcinoma (US-G1) and higher grade hepatocellular carcinoma (US-G2/G3). Immediately after contrast enhanced ultrasound-grading, biopsies of hepatocellular carcinoma-lesions (n=95, 1.2-12.5 cm) were obtained and analysed for tumour grading (G). Descriptive statistics, sensitivity, specificity positive and negative predictive values, diagnostic likelihood ratios and interoperator reproducibility were calculated (κ).
  
  
  RESULTS
  Histologically 77 (81.1%) patients had G2-G3 and 18 (18.9%) had G1 tumours. Higher grade hepatocellular carcinoma showed more often a washout in the portal or late phase (p<0.0001). The sensitivity, specificity, positive predictive values and negative predictive values of contrast enhanced ultrasound for grading of hepatocellular carcinoma for all patients were 94% (CI: 72-99%), 95% (CI: 88-99%), 81% and 99% and for patients with tumours<5 cm 100%(95% CI: 79-100), 96% (95% CI: 80-99), 92% and 100%. Positive and negative diagnostic likelihood ratios' were 18 and 26 and 0.06 and 0, respectively. κ=0.941 (p<0.001).
  
  
  CONCLUSIONS
  Contrast enhanced ultrasound has a high diagnostic value and reproducibility for non-invasive grading of hypervascular hepatocellular carcinoma >1cm in patients with liver cirrhosis.
authors.affiliation: Hannover Medical School, Department of Gastroenterology, Hepatology and Endocrinology, Hannover, Germany. boozari.bita@mh-hannover.de
authors.forename: Bita
authors.initials: B
authors.lastname: Boozari
authors.forename: Bisharah
authors.initials: B
authors.lastname: Soudah
authors.forename: Kinan
authors.initials: K
authors.lastname: Rifai
authors.forename: Sabine
authors.initials: S
authors.lastname: Schneidewind
authors.forename: Arndt
authors.initials: A
authors.lastname: Vogel
authors.forename: Hartmut
authors.initials: H
authors.lastname: Hecker
authors.forename: Andreas
authors.initials: A
authors.lastname: Hahn
authors.forename: Jerome
authors.initials: J
authors.lastname: Schlue
authors.forename: Christoph F
authors.initials: CF
authors.lastname: Dietrich
authors.forename: Matthias J
authors.initials: MJ
authors.lastname: Bahr
authors.forename: Stefan
authors.initials: S
authors.lastname: Kubicka
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.forename: Michael
authors.initials: M
authors.lastname: Gebel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods
chemical_list: D003287:Contrast Media